Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Sonnenfeld N [original query] |
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Recommended use of aspirin and other antiplatelet medications among adults--National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, United States, 2005-2008
George MG , Tong X , Sonnenfeld N , Hong Y . MMWR Suppl 2012 61 (2) 11-8 Cardiovascular disease (CVD) is the most highly prevalent disease in the United States and remains the leading cause of death among adults aged ≥18 years despite advancements in treatment and prevention in recent decades. Each year, approximately 800,000 persons die from CVD, which includes coronary heart disease (CHD); the majority of those persons who die from CVD had underlying atherosclerosis. Approximately 7.9 million U.S. adults have a history of heart attack, approximately 7 million U.S. adults have a history of stroke, and, approximately 16 million U.S. adults have received a diagnosis of CHD. CVD and CHD cause a substantial economic burden in the United States. In 2010, the estimated annual cost (direct and indirect) of CVD in the United States was approximately $450 billion, including $109 billion for CHD and $54 billion for stroke alone. |
Emergency department volume and racial and ethnic differences in waiting times in the United States
Sonnenfeld N , Pitts SR , Schappert SM , Decker SL . Med Care 2012 50 (4) 335-41 BACKGROUND: Racial and ethnic differences in emergency department (ED) waiting times have been observed previously. OBJECTIVES: We explored how adjusting for ED attributes, particularly visit volume, affected racial/ethnic differences in waiting time. RESEARCH DESIGN: We constructed linear models using generalized estimating equations with 2007-2008 National Hospital Ambulatory Medical Care Survey data. SUBJECTS: We analyzed data from 54,819 visits to 431 US EDs. MEASURES: Our dependent variable was waiting time, measured from arrival to time seen by physician, and was log transformed because it was skewed. Primary independent variables were individual race/ethnicity (Hispanic and non-Hispanic white, black, other) and ED race/ethnicity composition (covariates for percentages of Hispanics, blacks, and others). Covariates included patient age, triage assessment, arrival by ambulance, payment source, volume, region, and teaching hospital. RESULTS: Geometric mean waiting times were 27.3, 37.7, and 32.7 minutes for visits by white, black, and Hispanic patients. Patients waited significantly longer at EDs serving higher percentages of black patients; per 25 point increase in percent black patients served, waiting times increased by 23% (unadjusted) and 13% (adjusted). Within EDs, black patients waited 9% (unadjusted) and 4% (adjusted) longer than whites. The ED attribute most strongly associated with waiting times was visit volume. Waiting times were about half as long at low-volume compared with high-volume EDs (P<0.001). For Hispanic patients, differences were smaller and less robust to model choice. CONCLUSIONS: Non-Hispanic black patients wait longer for ED care than whites primarily because of where they receive that care. ED volume may explain some across-ED differences. |
Changing methods of NCHS surveys: 1960-2010 and beyond
Sirken MG , Hirsch R , Mosher W , Moriarity C , Sonnenfeld N . MMWR Suppl 2011 60 (4) 42-8 The year 2011 marks the 50th anniversary of CDC's publication of MMWR. It also marks the 24th anniversary of the National Center for Health Statistics (NCHS) joining CDC in 1987. One of NCHS's greatest contributions to public health has been in surveys and survey methodology. Today, more than 50 years after NCHS was formed in 1960, NCHS continues to conduct some of the leading health surveys of the United States. This report describes some of the many innovations and changes in NCHS survey methods during the past 50 years and briefly previews how the methods might change in the future. |
Trends in emergency department visits among Medicaid patients
Sonnenfeld N , Decker SL , Schappert SM . JAMA 2011 306 (11) 1202-3; author reply 1203 Dr Tang and colleagues1 concluded that emergency department (ED) visit rates have been increasing most among Medicaid patients. We believe this conclusion may be unwarranted. The analysis does not appear to have incorporated changes that occurred over the years in the coding of the variable “primary expected source of payment” in the data source used by the authors, the National Hospital Ambulatory Medical Care Survey (NHAMCS) conducted by the National Center for Health Statistics (NCHS). The only information on payment sources that NHAMCS collected from 1997 through 2004 was the primary expected source of payment.2 Starting in 2005, hospital respondents could indicate multiple expected sources of payment per visit and did not designate a primary source. From 2005 through 2007, the data files included separate variables for each expected payment source plus a variable that assigned the primary expected source using a hierarchy with Medicaid first, followed by Medicare, private insurance, worker's compensation, self-payment, and no charge. | We suspect that many hospital respondents from 1997 through 2004 reported Medicare as the primary expected payment source for patients dually eligible for Medicare and Medicaid. It appears that for 2007, Tang et al used NHAMCS’ hierarchical payment variable that classified dual eligibles as having Medicaid. This approach led to a report of ED visit rates between 1997 and 2007 that increased by 36.5% for adult patients with Medicaid and decreased by 2.5% for Medicare (Table in the article). We recomputed the number of visits by coding the primary payment source for dually eligible patients as Medicare instead of Medicaid for 2007. Using information in the Table1 to generate denominators for the visit rate, the estimated number of ED visits for Medicaid patients would be 14.2 million and the visit rate 759.9 per 1000; for Medicare, the number of visits would be 19.9 million and the visit rate 485.9 per 1000. Therefore, the visit rate for adults from 1997 through 2007 would increase 9.5% for Medicaid and 17.6% for Medicare. These latter estimates may be more realistic than those presented by Tang et al. |
Racial differences in functioning among elderly nursing home residents, 2004
Jones AL , Sonnenfeld NL , Harris-Kojetin LD . NCHS Data Brief 2009 (25) 1-8 Reducing racial disparities in health care is an important national policy goal. Previous research on racial disparities has focused on nursing home placement rates. Recent research suggests that black nursing home residents may be more likely than residents of other races to reside in facilities that have serious deficiencies, such as low staffing ratios and greater financial vulnerability. In 2004, 11% of the 1.3 million nursing home residents aged 65 and over in the United States were black. National descriptions of black nursing home residents are limited. Using data from the most recent National Nursing Home Survey, this report highlights differences observed between elderly black nursing home residents and residents of other races in functioning and resident-centered care. The specific measures highlighted are functional status, incontinence, and management of incontinence. |
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